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Tsalik EL, Petzold E, Kreiswirth BN, Bonomo RA, Banerjee R, Lautenbach E, Evans SR, Hanson KE, Klausner JD, Patel R. Advancing Diagnostics to Address Antibacterial Resistance: The Diagnostics and Devices Committee of the Antibacterial Resistance Leadership Group. Clin Infect Dis 2017; 64:S41-S47. [PMID: 28350903 DOI: 10.1093/cid/ciw831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diagnostics are a cornerstone of the practice of infectious diseases. However, various limitations frequently lead to unmet clinical needs. In most other domains, diagnostics focus on narrowly defined questions, provide readily interpretable answers, and use true gold standards for development. In contrast, infectious diseases diagnostics must contend with scores of potential pathogens, dozens of clinical syndromes, emerging pathogens, rapid evolution of existing pathogens and their associated resistance mechanisms, and the absence of gold standards in many situations. In spite of these challenges, the importance and value of diagnostics cannot be underestimated. Therefore, the Antibacterial Resistance Leadership Group has identified diagnostics as 1 of 4 major areas of emphasis. Herein, we provide an overview of that development, highlighting several examples where innovation in study design, content, and execution is advancing the field of infectious diseases diagnostics.
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Affiliation(s)
- Ephraim L Tsalik
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, and.,Emergency Medicine Service, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Elizabeth Petzold
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, and
| | - Barry N Kreiswirth
- Public Health Research Institute Tuberculosis Center, New Jersey Medical School-Rutgers University, Newark
| | - Robert A Bonomo
- Department of Medicine, Case Western Reserve University School of Medicine, and.,Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Ritu Banerjee
- Division of Pediatric Infectious Diseases, Vanderbilt University, Nashville, Tennessee
| | - Ebbing Lautenbach
- Department of Medicine, Division of Infectious Diseases, the University of Pennsylvania School of Medicine, Philadelphia
| | - Scott R Evans
- Center for Biostatistics in AIDS Research and the Department of Biostatistics, Harvard University, Boston, Massachusetts
| | - Kimberly E Hanson
- Departments of Medicine and Pathology, Divisions of Infectious Diseases and Clinical Microbiology, University of Utah, Salt Lake City
| | - Jeffrey D Klausner
- UCLA David Geffen School of Medicine and Fielding School of Public Health, Los Angeles, California
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Doi Y, Bonomo RA, Hooper DC, Kaye KS, Johnson JR, Clancy CJ, Thaden JT, Stryjewski ME, van Duin D. Gram-Negative Bacterial Infections: Research Priorities, Accomplishments, and Future Directions of the Antibacterial Resistance Leadership Group. Clin Infect Dis 2017; 64:S30-S35. [PMID: 28350901 DOI: 10.1093/cid/ciw829] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Antimicrobial resistance in pathogenic gram-negative bacteria is one of the most pressing challenges in the field of infectious diseases and is one of 4 key areas of unmet medical need identified by the Antibacterial Resistance Leadership Group (ARLG). The mission of the Gram-Negative Committee is to advance our knowledge of these challenging infections and implement studies to improve patient outcomes. Studies have fallen primarily into 2 broad categories: prospective cohort studies and interventional trials. Among the observational studies, CRACKLE (Consortium on Resistance Against Carbapenems in Klebsiella pneumoniae and Other Enterobacteriaceae) has contributed seminal multicenter data describing risk factors and clinical outcomes of carbapenem-resistant Enterobacteriaceae (CRE) in sentinel US hospitals. Building on this success, CRACKLE II will expand the network to hospitals across the United States and Colombia. Similar protocols have been proposed to include Acinetobacter baumannii and Pseudomonas aeruginosa (SNAP and POP studies). In addition, the CREST study (Carbapenem-Resistant Enterobacteriaceae in Solid Organ Transplant Patients) has provided pivotal data on extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and CRE carriage among solid organ transplant recipients to inform management of this vulnerable patient population. Two clinical trials to define novel ways of using an existing antibiotic, fosfomycin, to treat ESBL-producing Enterobacteriaceae (one that has completed enrollment and the other in late protocol development) will determine the clinical efficacy of fosfomycin as step-down oral therapy to treat complicated urinary tract infections. Additional clinical studies and trials using immunotherapeutic or newly approved agents are also in the planning stage, with the main goals of generating actionable data that will inform clinical decision making and facilitate development of new treatment options for highly resistant gram-negative bacterial infections.
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Affiliation(s)
- Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
| | - Robert A Bonomo
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Departments of Medicine, Pharmacology, Biochemistry and Molecular Biology, and Microbiology, Case Western Reserve University, Cleveland, Ohio
| | - David C Hooper
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
| | - Keith S Kaye
- Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor
| | | | - Cornelius J Clancy
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
| | - Joshua T Thaden
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Martin E Stryjewski
- Department of Medicine, Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno," Ciudad Autónoma de Buenos Aires, Argentina; and
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill
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Doernberg SB, Lodise TP, Thaden JT, Munita JM, Cosgrove SE, Arias CA, Boucher HW, Corey GR, Lowy FD, Murray B, Miller LG, Holland TL. Gram-Positive Bacterial Infections: Research Priorities, Accomplishments, and Future Directions of the Antibacterial Resistance Leadership Group. Clin Infect Dis 2017; 64:S24-S29. [PMID: 28350900 DOI: 10.1093/cid/ciw828] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Antimicrobial resistance in gram-positive bacteria remains a challenge in infectious diseases. The mission of the Gram-Positive Committee of the Antibacterial Resistance Leadership Group (ARLG) is to advance knowledge in the prevention, management, and treatment of these challenging infections to improve patient outcomes. Our committee has prioritized projects involving methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) due to the scope of the medical threat posed by these pathogens. Approved ARLG projects involving gram-positive pathogens include (1) a pharmacokinetics/pharmacodynamics study to evaluate the impact of vancomycin dosing on patient outcome in MRSA bloodstream infection (BSI); (2) defining, testing, and validating innovative assessments of patient outcomes for clinical trials of MRSA-BSI; (3) testing new strategies for "step-down" antibiotic therapy for MRSA-BSI; (4) management of staphylococcal BSIs in neonatal intensive care units; and (5) defining the impact of VRE bacteremia and daptomycin susceptibility on patient outcomes. This article outlines accomplishments, priorities, and challenges for research of infections caused by gram-positive organisms.
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Affiliation(s)
- Sarah B Doernberg
- Division of Infectious Diseases, University of California, San Francisco
| | | | - Joshua T Thaden
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Jose M Munita
- Division of Infectious Diseases, University of Texas Health Sciences Center, Houston.,Clinica Alemana, Universidad del Desarrollo, Chile
| | - Sara E Cosgrove
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cesar A Arias
- Center for Antimicrobial Resistance and Microbial Genomics, Division of Infectious Diseases, University of Texas Health Sciences Center, Houston
| | - Helen W Boucher
- Division of Infectious Diseases, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - G Ralph Corey
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Franklin D Lowy
- Division of Infectious Diseases, Columbia University Medical Center, New York, New York
| | - Barbara Murray
- Division of Infectious Diseases, University of Texas Health Sciences Center, Houston
| | - Loren G Miller
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; and
| | - Thomas L Holland
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.,Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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Chambers HFC, Cross HR, Evans SR, Kreiswirth BN, Fowler VG. The Antibacterial Resistance Leadership Group: Progress Report and Work in Progress. Clin Infect Dis 2017; 64:S3-S7. [PMID: 28350896 PMCID: PMC5850447 DOI: 10.1093/cid/ciw824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Antibacterial Resistance Leadership Group (ARLG), with funding from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, was created in June 2013. Its mission is to develop, prioritize, and implement a clinical research agenda that addresses the public health threat of antibacterial resistance. This article reports on the progress that the ARLG has made to date in fulfilling its mission. Since inception, the ARLG has received and reviewed >70 study proposals, initiated >30 studies, executed >300 agreements, included data from >7000 subjects, published >45 manuscripts, and provided opportunities for 26 mentees. Despite this substantial progress, there remains significant work to be accomplished. This article also describes the considerable challenges that lie ahead.
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Affiliation(s)
| | - Heather R Cross
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Scott R Evans
- Center for Biostatistics in AIDS Research and Department of Biostatistics, Harvard University, Boston, Massachusetts
| | - Barry N Kreiswirth
- Public Health Research Institute Tuberculosis Center, New Jersey Medical School-Rutgers University, Newark; and
| | - Vance G Fowler
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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